[NOHARMM note: This 1959 medical journal
article describes a female condition that is analogous to
phimosis of the male foreskin and reveals how American medicine condoned genital
interventions on females
with arguments similar to those still used today to justify male circumcision.
We offer this article for historical reference only, as well as to emphasize these
similarities and expose medical arrogance.]

The infant clitoris is hidden, covered by the prepuce. The midline
raphe may not open sufficiently in later life. A variety of symptoms can develop,
attributable to accumulation and contamination of smegma. In these instances, the simple
expedient of probing and cleansing can be rewarding.

When we were interns, 33 years ago, the staffroom conversation one day
came around to the clitoris of the female infant. As I remember, the sum total of
knowledge of the subject among those present was zero. I became curious. In the nursery I
learned something I had not learned from school or from books, namely that the infant
clitoris is hidden. The prepuce covers it at birth. The midline raphe invariably is
intact.

If the male needs circumcision
for cleanliness and hygiene, why not the female?

When does the raphe open? Throughout the years, in practice, I found that
it may remain intact even into multiparous life. Also I have found that when the raphe
does not open, smegma accumulation can cause trouble. Moreover, if the raphe opens only a
pinpoint, bacteria can enter to cause contamination of the debris. This, then, can cause
symptoms. If, at about two years of age, a little girl has not opened the raphe by
exercises like riding kiddy-bikes, or by self-examination, or if the raphe has not opened
spontaneously, there usually is found an area of irritation. This is especially so if a
very small opening is present. Then come the symptoms of irritation, scratching,
irritability, masturbation, frequency and urgency. In adults, the same conditions exist,
with associated smegmaliths that may cause dyspareunia and frigidity.

If the male needs circumcision for cleanliness and hygiene, why not the
female? I have operated on perhaps 40 patients who needed this attention.

Illustrative Cases

A youngster was suspected of having epilepsy. At about two years of age,
she was brought to my office with the mother and was left alone while I examined the
mother. I noticed the child masturbating by rubbing back and forth in a sitting position.
She finally toppled over in hyperventilation. The disorder disappeared with the simple
expedient of female circumcision and the cleansing away of irritants.

Adult women with three or four children have been seen whose chief
complaint was dyspareunia. Examination revealed a rosary-like group of nodules under the
prepuce of a hidden clitoris. Female circumcision was done. Smegmaliths were cleansed
away. Very thankful patients were the reward. For the first time in their lives, sex
ambition became normally satisfied.

Most of the patients have been children 2 to 10 years old who complained
of signs and symptoms that suggested cystitis. Urine analyses were usually negative.

The mothers complained about the irritability of the children, their
unusual habits and sometimes their bedwetting. When examination revealed the presence of a
hidden or partially hidden clitoris, it was a simple procedure for the doctor to effect
return to normality.

The same reasons
that apply for the circumcision of malesare generally valid when considered for the female.

The Technique

The procedure is easy. However, it is so distressing to the patient that
general anesthesia should be used to avoid making an enemy for life. A blunt probe is
inserted into the raphe and swung around the head of the clitoris. There is usually no
bleeding, or at least very little.

The area is then cleansed of contaminant debris or of smegma that
occasionally is formed into stones of various sizes. The raphe normally should be open in
early childhood. It is seldom that the prepuce will overgrow again once it has been
opened. The mother should be carefully instructed about teaching the child hygienic
habits.

The signs and symptoms caused by contaminated smegma, retained smegma or
smegmaliths usually clear up when the cause is removed. The same reasons that apply for
the circumcision of males are generally valid when considered for the female.

Technique of circumcision.A blunt probe is inserted intothe raphe and swung aroundthe head of the clitoris.